Medicare Advantage Models
Expert articles and analysis related to medicare advantage models.
AI Summary — Last 7 Days
The Trump CMS is injecting new volatility into Medicare Advantage economics by recalculating 2026 Star Ratings after the Clover litigation, with upside locked in for plans that benefit but limited average-sector movement—reinforcing that quality bonus revenue remains legally and methodologically fragile for MA-focused VBC strategies (Healthcare Dive). At the same time, CMS finalized a 2.48% MA payment increase for 2027 while RADV extrapolation and OIG scrutiny of MA denials intensify, creating a split signal for payers and risk-bearing providers: benchmark growth may support bids and supplemental benefits, but coding, audit, utilization management, and compliance exposure are becoming more central to model performance (Wakely RADV guide).
Related Articles
Approved but Underpaid: How Payers are Quietly Redrawing the Rules of Hospital Reimbursement
The following is a guest article by Missy Harbert, Senior Solution Advisor at Revecore For years, hospitals have built denial management programs around a predictable premise: when a payer disputes a ...
STAT+: CMS recalculates Medicare Advantage star ratings again, adding more volatility to program
Medicare Advantage plans that receive four out of five stars or better get bonus payments, which have ballooned to $16 billion this year.
What Upstream Prior Authorization Denials Mean for Home Health Providers
CMS recalculates Medicare Advantage stars after Clover lawsuit loss, but not a freebie for plans
Regulators are locking in new 2026 stars for plans if they’re higher under the new methodology. But the recalculation basically results in no change to average star ratings unless you’re Clover, analy...
OIG Publishes Medicare Advantage Industry-Specific Guidance
OIG Publishes Medicare Advantage Industry-Specific Guidance  JD Supra
Medicare Advantage RADV Extrapolation: A Practical Guide for Plans
Learn how CMS determines Medicare Advantage RADV extrapolation, why audit outcomes can vary, and what factors drive repayment risk. Download Wakely’s practical guide for MA plans. Understand the Stati...
Cancer Center Network Breadth Not Linked to Lower MA Disenrollment Rates
Better Medicare Alliance Statement on MedPAC’s June 2026 Report to Congress
Better Medicare Alliance Statement on MedPAC’s June 2026 Report to Congress  Better Medicare Alliance
2. MA patients stay in hospital 11% longer than those with traditional Medicare
2. MA patients stay in hospital 11% longer than those with traditional Medicare - Becker's Payer Issues  beckerspayer.com